Opt for dying with pain-free dignity

How much will you endure when you're dying? Many patients say, "I want enough painkiller to prevent all pain." Others add, "When there's no further hope of survival, give me sufficient medication to end my misery." Recently the University of Toronto Joint Centre For Bioethics issued new guidelines fordoctors who treat pain. But how much pain will they stop?

The new guidelines were developed by physicians, intensive care program directors and coroners.

The guidelines state that there is no limit to the amount of painkiller that can be given to relieve pain. In fact, they say that doctors should not hesitate to increase the dose of painkillers even if it hastens death.

Another section of this outline states that patients may be rendered unconscious if this is the only way to ease pain. Moreover, they may be kept in this state for as long as it takes for a fatal illness to kill them. This is known as "terminal sedation" and the bioethics committee suggests this is the difference between palliative care and euthanasia.

But what sense does it make to keep loved ones in a coma for days, weeks or even years with tubes coming out of every orifice in their bodies before they die? If this is dying with dignity, I want none of it. And what aboutthe family who have to witness this, day after day?

VEGETATIVE STATE

Moreover, how can doctors draw a clear line between palliative care and euthanasia when they can prescribe painkillers that hasten death? Or keep patients in a vegetative state until they die? Surely this is just playing with words. It's better described as slow euthanasia.

What the committee proposes would be difficult enough to follow in a well-staffed, specialized, palliative care centre. However, there are few of these centresin Canada. In the real world, the luck of the Irish is needed to obtain good pain control.

And I doubt these guidelines will resolve the fears of doctors. Many fear that hospital staff will complain they've given too much narcotic and are practicing euthanasia. The recent picture of one dedicated doctor being taken to jail in handcuffs for this reason is hard to erase.

Patients suffer needlessly because some professional people continually fight euthanasia. Margaret Sommerville, a law professor and a director of the McGill Centre for Medicine Law and Ethics, continues to oppose euthanasia.

In her recent book, Death Talk, she asks us to think of "secular trust, "whatever that means. She also adds that we should "sing the song of life,the lyrics of love." However, she fails to inform us how these lyrics will stop the agony of terminal cancer.

Sommerville uses phrases that mean nothing, like so many others who believe they have a moral right to tell us how to die. In their infinite wisdom, they know something that eludes the rest of us.

In 1998, the Gifford-Jones Foundation gave half a million dollars to establisha Professorship in Pain Control and Palliative Care at the University of Toronto. These funds came from readers of this column and were intended tohelp people die free of pain.

NO HOPE OF RECOVERY

If I had another half million, I'd go the next step and establish a Society For The Prevention of Cruelty to Humans. This organization would fight forthe right to end life when there is no hope of recovery.

Patient Assisted Death is now legal in Holland, Belgium and the state of Oregon. Patients requesting such help have to be of sound mind and facing a future of unbearable suffering. The doctor must be convinced that thereis no other solution and he must seek a second opinion.

What do you think?

To protect myself against needless suffering, I've signed The Gifford-Jones Living Will. It can be obtained by sending a self-addressed stamped envelope to Dr. W. Gifford-Jones, First Canadian Medical Centre, 1 First Canadian Place, P.O. Box 119, Toronto, ON, M5X 1A4, plus $5.00 to cover the cost. And if you want free medical updates on medical matters, periodically visit the Gifford-Jones Web site.